Poneke Kyokushin Registration Form
Please complete this form once for each person who may be interested in becoming a member.

This completed form will be emailed to the address provided. Please print the completed form and give it to the instructor when you arrive at your first session.

Someone will be in touch with you to discuss membership. You will not be registered as a member of Poneke Dojo until you confirm your interest by becoming financial / paying on invoice.
Personal Information
Student's First Name *
Surname *
Date of Birth *
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Gender *
Contact Details
Contact Name (Parent or Guardian for kids)
Mobile Phone Number
Other Phone Number
Email Address *
Street Address *
Suburb
City *
Postcode
Any Other Contact Information
Training Preferences
Select up to two options *
Required
Select preference *
Based on student age, size, maturity and personal goals
To help the Club
How did you hear about Poneke Dojo?
Acknowledgements
Kyokushin Karate is a traditional Japanese martial art that requires intense physical exertion. Full contact fighting is a component of Kyokushin. While every effort is made to protect the comfort and safety of all students there is an inherent risk of pain and injury.
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